Photo: Gwamaka Charles., Wikimedia Commons, CC BY-SA 4.0ZHSF: the Zanzibar Health Services Fund explained
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What ZHSF is
The Act was passed by the House of Representatives of Zanzibar on 28 February 2023 and assented to by the President of Zanzibar in March 2023 (ZHSF Act). Its objectives are access to reliable and sustainable health services for all citizens and residents of Zanzibar, and sustainable financing for them (s.6).
The Fund registers members and health service providers, collects contributions, pays for the health services of members and their dependants, inspects and accredits providers and keeps a record of each member's contributions and services (s.7).
ZHSF is separate from the mainland's NHIF: Zanzibar has its own fund, its own membership card and its own contribution rate. For the mainland fund, see NHIF packages and NHIF registration.
Who must join
Section 2(1) lists the people the Act applies to:
- workers in the public and private sector;
- workers in the informal sector (the self-employed and those working for them, off payroll);
- foreigners living in Zanzibar for more than six months;
- retirees;
- students in colleges and higher-education institutions in Zanzibar, unless they are already covered as dependants;
- all residents of Zanzibar.
Implementation started with the first group — public and private sector employees — who had to register as soon as the Act came into force (s.2(2)). The other groups join when the Minister publishes a notice in the Gazette (s.2(3)).
Contributions: 7% of salary
| Rule | What the Act says | Section |
|---|---|---|
| Total rate (public and private sector) | 7% of the employee's consolidated salary | Second Schedule, item 1 |
| Employer's share | 3.5% of the consolidated monthly salary | Second Schedule, item 2(1) |
| Employee's share | 3.5% of the consolidated monthly salary, every month | Second Schedule, item 2(2) |
| Deadline | Remitted by the employer within 14 days after the end of each month | s.22(3) |
| Informal sector and other groups | Rates set by the Minister and published in the Gazette | s.22(2); Second Schedule, item 3 |
| Tax | No income tax on contributions and benefits; no stamp duty on the Fund's receipts | s.49 |
Example, using the Act's rates: on a consolidated salary of TZS 1,000,000 a month, the employer pays TZS 35,000 and deducts TZS 35,000 from the employee, so TZS 70,000 reaches the Fund. The employer must also send the list of employees for registration within 30 days of employing someone (s.20(2)).
Who counts as a dependant
The Act's definition (s.3) covers:
- a biological child;
- an adopted or foster child whose essential needs are under the member's supervision;
- a spouse and a parent who are not in the formal or informal sector and have no income to contribute.
A spouse or parent with an income is therefore a member in their own right, not a dependant.
What ZHSF pays for
The Third Schedule sets the benefit package. It includes:
- medical consultation; outpatient and inpatient services;
- laboratory tests, radiology and other diagnostic services;
- medicines and medical supplies registered and approved in Zanzibar;
- oral and dental services; eye and ENT services; physiotherapy and rehabilitation;
- dialysis and cancer treatment;
- reproductive services and maternal and child services;
- specialist services, mental health, emergency and intensive care;
- assistive devices for people with disabilities, orthotics and prosthetics.
Excluded: cosmetics and cosmetic surgery, illegal abortions and unauthorised drugs. A CT scan, MRI or other costly diagnostic or treatment such as cancer care and dialysis needs the Fund's prior approval, except in an emergency. A waiting period for each group is set by regulations (s.25), and treatment outside Zanzibar follows a special procedure of the Fund (s.27).
The membership card the Fund issues after registration is used to identify and verify the member when they need care (s.21).
Penalties
| Offence | Penalty | Section |
|---|---|---|
| Employer does not remit contributions | Fine of at least TZS 5 million, or 1 year in prison, or both, plus the unpaid contributions | s.22(4)–(5) |
| Employer does not submit employees for registration | Fine of at least TZS 1 million, or at least 6 months in prison, or both, plus contributions for the whole period | s.42(2)–(3) |
| A person required to register who does not | Liable for the contributions for the entire period not registered | s.42(1) |
| False information to avoid contributing or to get services, falsifying a membership card, obtaining a benefit not due, not paying contributions | Fine of at least TZS 2 million, or at least 1 year in prison, or both | s.41 |
From the ZHSF Act.
Visitors, the mainland and NHIF
Section 45 obliges any foreigner coming to Zanzibar to have health insurance that applies in Zanzibar; without it, they pay their medical costs themselves. For tourists this is the mandatory inbound travel policy of the Zanzibar Insurance Corporation — see Zanzibar travel insurance.
Section 46 lets the Fund sign agreements with other health insurance funds in Tanzania. The press reported in June 2024 that ZHSF and NHIF signed such an accord so that Zanzibar members can be treated at NHIF-accredited centres (The Guardian, press report); ask ZHSF which mainland facilities accept your card before you travel.
Private health insurance sold in Zanzibar is regulated by TIRA — see health insurance in Tanzania.
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Frequently asked questions
What is ZHSF?
The Zanzibar Health Services Fund, established by the Zanzibar Health Services Fund Act, 2023 (Act No. 1 of 2023), to pay for the health services of its members and their dependants in Zanzibar.
What is the ZHSF contribution rate?
7% of the consolidated salary for public and private sector employees: 3.5% paid by the employer and 3.5% by the employee (Second Schedule of the Act).
When must employers pay ZHSF contributions?
Within 14 days after the end of each month (s.22(3)). Failing to remit is an offence punishable by a fine of at least TZS 5 million, one year in prison, or both.
Who is a dependant under ZHSF?
A biological, adopted or foster child, and a spouse or parent who has no income and is not in the formal or informal sector (s.3).
Does ZHSF cover CT scans and MRI?
Yes, as part of the benefit package, but a CT scan, MRI, cancer treatment or dialysis needs the Fund's prior approval except in an emergency.
Is ZHSF the same as NHIF?
No. ZHSF is Zanzibar's fund under its own 2023 Act; NHIF is the National Health Insurance Fund of the mainland under Cap. 395. The Act allows agreements between them (s.46).